Chloramphenicol: the good, the bad, and the "beware"

As we see more and more infections caused by antibiotic-resistant bacteria, we have to re-think our approach towards antibiotic therapy. This often involves using new drugs, but sometimes it also involves considering the use of older drugs that we haven't used very much for a long time.

One such drug is chloramphenicol. Years ago, this antibiotic was widely used, and is still used in people and animals in some situations. In some respects, it is a very good antibiotic - it is often effect against many bacteria including those that are resistant to many other drugs, such as MRSA and MRSI/MRSP.  Chloramphenicol can also be given orally, and it's relatively cheap. Unfortunately this drug can also be very toxic, both to the animals being treated with it and to people that come in contact with with it in the process. In some animals, chloramphenicol can cause suppression of the bone marrow, where red and white blood cells are produced. This is more of a concern with long term use, but if the bone marrow does become suppressed, stopping treatment with the chloramphenicol typically resolves the problem.  Unfortunately, this bone marrow suppression is much more of a concern in people - the supression is very severe, and can occur with exposure to even a very low dose (or probably single dose) of chloramphenicol.  This results in a condition known as aplastic anemia,  which it typically fatal.  Fortunately this reaction is very rare in people, but there is no way to predict who might develop this condition, and since it is usually fatal, we obviously need to be cautious about using this drug. In some countries, chloramphenicol use in banned in all animals. In many others, it cannot be used in food animals, but can be used in pets.

  • Chloramphenicol should only be used as a drug of last resort. There are situations where it is useful and may be life-saving, but the human health risks cannot be overlooked.
  • If chloramphenicol is being considered, it is critical that  people who would need to handle the drug understand the risk and how to safely handle the drug to avoid exposure.
  • Chloramphenicol tablets should not be crushed or otherwise processed at home because of the potential for breathing in the drug when it is in powder form.

Direct contact with pills or liquids should be avoided by use of gloves or other safe handling practices.

  • If a liquid form is used and is squirted onto food, the food bowl should be handled as if it is contaminated.
  • If pills are being used, the animal should be observed to ensure that the pill is ingested and not spit up and left on the floor.
  • Contact with the mouth and face and animals that are being treated with chloramphenicol should be avoided in case drug residues are present.

If people are unable or unwilling to follow safe handling recommendations, they should not use this drug.

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